Review paper osteoarthritis and its possible treatments
Osteoarthritis and its possible treatmentsValeria Rivera University of Puerto Rico-Cayey, Cayey, PR 00736Abstract Arthritis affects millions of people per year. Around, 350 million people in theworld. It is a disease that everyone could suffer from. The risks are higher after the age of40. Some risks include obesity, joint malformation, injuries, and inheritance.Osteoarthritis (OA) is the most common type of arthritis in humans and in dogs. There isno specific treatment whatsoever, but there are some possible treatments depending onseverity of the disease and personal reactions. This paper focuses on nutrients likeGlucosamine/ Chondroitin Sulfate, Col-3 Inhibition, NSAID, physical rehabilitation, andsurgery. Researchers, such as McCarty et al. 2006, obtained positive effects using Glu/CSfrom day 70. PROM exercise is widely used as therapy for dogs as well as physicalrehabilitation. This involves the use of physical agents like hear water, cold, andelectricity (Johnston et al., 2008).Keywords: Osteoarthritis; Canines; Treatments; Surgery1. Introduction treatments that are still on trial since Arthritis includes the different there is not a completely convincingjoint degradation and inflammation that determined treatment for OA. The mostoccur in most joint disorders. The most commonly used and recommendedcommon type of arthritis is treatment is Nonsteroidal anti-Osteoarthritis (OA). Twenty-five per inflammatory drugs (NSAIDs).cent (25%) to 30% of dogs suffer fromarthritis or hip dysplasia. It is described 2. Glucosamine hydrochloride andby a low level of inflammation that Chondroitin Sulfateincreases to degenerate joints. Arthritis The first article to report the usecan be caused by injuries, obesity, of Glucosamine/Chondroitin Sulfateinheritance, and joint malformation. (Glu/CS) as a treatment for osteoarthritisPatients of arthritis are all over the world in dogs used carprofen as a positiveand total approximately 350 million control (McCarty et al., 2006). Thirty-people. Commonly, symptoms begin at five dogs (Canis familiaris) withthe age of 40. Blood and urine test are osteoarthritis were clinically examinedtaken as examinations of arthritis along in the research. This research included awith x-rays. Symptoms comprise pain, pre-treatment evaluation where sampleslameness and muscle atrophy, swelling were collected for baseline hematologyof joints, stiffness, and lost of mobility. (blood tests). The researchers orally Other animals such as cats and induced the recommended dose ofhorses suffer from osteoarthritis. Dogs Glu/CS in 16 dogs and the suggestedare excellent models for studying amount, as well, of carprofen in 19 dogs.osteoarthritis and can even be cured Dogs weighing 5-19 kg (11-39lbs) wereduring test treatments. Neither a specific given 1g of the Glu/CS twice daily. Dogscure nor treatments for Osteoarthritis weighting 20-40 kg (40-82lbs) were(OA) currently exist. There are some given 1.5g twice daily. Dogs weighing
40 kg (82lbs) or over were given 2g better results and an improvement in thetwice daily. For the positive control use of glucosamine hydrochloride andcarprofen, dogs were given 2mg/kg body chondroitin sulfate as indicated byweight twice daily for 7 days. After that, McCarthy et al. Chondoprotectant is adaily maintenance dose for dogs was term used to designate compounds that2mg/kg body weight. These dogs were have a positive effect on the health andre-evaluated by veterinarians who metabolism of chondrocytes andrecorded observations with a scoring synoviocytes. Some of the expectedsystem based on lameness, joint outcomes cover an enhancement inmobility, pain on palpation, weight- metabolism of chondrocyte andbearing, and an overall score of clinical synoviocyte that can potentially suppresscondition ranging from 1 to 5 from not inflammation. It inhibits degradativeaffected to very severely affected. enzymes within the synovial fluid andEvaluations were taken on days 14, 42, cartilage matrix and also inhibits the70 and 98. Treatment ended on day 70. formation of clots in small blood vesselsVeterinarians and owners were in the joint area as cited by Beale inunfamiliar with the treatments provided. McCarthy et al., 2006. Convincing results ofimprovements in pain, weight-bearing 3. COL-3 inhibitionand overall condition, were obtained Joint degradation is determinedfrom day 70 when using Glu/CS as a in matrix-degrading proteases bytreatment for dogs with osteoarthritis. articular tissues. In this case, matrixImprovements of dogs using carprofen metalloproteinase (MMPs) andwere obtained at a faster rate - in day 42 cathepsins are used. MMPs areunlike for dogs treated with Glu/CS. proteases that break peptide bonds insideNevertheless, the usage of Glu/CS over protein molecules into polymers.time, (until day 98) produced better Researchers used (6 diethyl)-6-deoxy-4-results than while using carprofen. dedimethylamino tetracycline COL-3 forAccording to McCarthy et. al, the use of arthritis therapy because it minimizesGlu/CS has been shown to protect production of MMPs and also inhibitsagainst chemically induced synovitis MMP activity, as Hanemaaijer et al., in(inflammation of the synovial Muir P 2007 noted. The cranial cruciatemembrane, the lining of the joints) in ligament (CCL), an important ligamentdogs by stimulating cartilage metabolism in the knee, can rapture causing jointand by inhibiting its degradation. A instability, pain, and lameness. Tosimilar consequence was obtained in explore a way of ameliorating jointreducing symptoms of OA in humans. degradation, researchers tested the Investigations demonstrated that effects of COL-3 on collagenthe use of Glu/CS in dogs with fragmentations of CCL. The CCL whereosteoarthritis has a satisfying clinical obtained from 33 client dogs duringeffect. (McCarthy et al. 2006) With these surgical treatment. The dogs were fromresults further research could be realized 5.3 to 2.6 years old and weighted aboutobserving the reaction of Glu/CS for a 10 to 36 kg (20 to 74 lbs.). Also, CCLsperiod longer than 70 days. A more were retracted from 13 other dogs withcomplex test, such as a force plate gait normal stifles. These were cultured in 12analysis, should be created to determine well plates with 1nL of culture medium
(Serum-free Dulbecco’s modified are cyclooxygenase inhibiting anti-Eagle’s medium with inflammatory drugs. Cyclooxygenase is20mMHEPES).Three explant culture an enzyme that forms prostaglandins(taking living material and placing it in a which causes inflammation. There aresubstance to preserve it) experiments two isoforms of COX, COX-1 andwere realized. The first experiment was COX-2. Both are found in canine’sduplicating the CCL, one for baseline kidneys. The recommended dose is 1 tocontrol and the other one for COL-3. In 2 mg/kg/day. DERAMAXX is only usedthe second experiment, the two CCL for dogs not humans. Like the majorityexplants were set up respectively. In the of the NSAIDS, DERMAXX canthird experiment, triplicate from each produce some side effects speciallyruptured CCL specimen were set. They when used with other NSAIDS.consisted of a positive inhibitor, a base According to The National Institute ofline control, and a protease inhibitor Health (NIH), DERAMAXX maycocktail. With their results, the produce gastrointestinal ulcerations andinvestigators concluded that using . inhibit prostaglandins which maintain0010M of COL-3 the degradation could normal homeostatic function.be inhibited. Researchers conducted an investigation using cloned canines cyclooxygenase with a dose of 2 to 4 mg/kg/day but4. NSAIDs DERAMAXX tablets did not inhibited Non-steroidal anti-inflammatory COX-1.Its clinical relevance has notdrugs (NSAID) are the most common been shown. In clinical trials oftreatment of osteoarthritis. They control DERAMAXX, healthy dogs were givenclinical signs of inflammation. daily doses, respective of body weightCarprofen is one of the newest NSAIDs 30 minutes after a meal. The process wasaccepted for use in dogs. A reasonable repeated for 60 days. No abnormalimprove in comfort is found using the findings were obtained, and physicalrecommended dosage of carprofen. tests were normal as well as urinary test.Some NSAIDs include Etodolac, The consumption of food and waterAspirine, and Firocoxib which has been remained normal and weight too.recently approved. Side effects includevomiting and diarrhea. 5. Physical rehabilitation Tepoxalin is a dual inhibitor of Physical rehabilitation involvescyclooxygenase (COX) and the use of physical agents consisting oflipoxygenase (LOX). As a result, the heat, cold, electricity, exercise, andgeneration of leukotrienes (fatty water. Positive improvements in terms ofmolecules of the immune system that blood flow are significant and reduce theincrease inflammation and asthma) are risk of muscle damage. Moist heat isdecreased, increasing recovery from used to increase blood flow in theinflammation. The patient will as a region. This helps in preventingconsequence feel less pain as COX and degradation of ligaments.LOX are inhibited. While using these pads the DERAMAXX is used in the temperature needs to be around 104 Fveterinary market to control pain and and 109 F, and the dog’s skin needs to beinflammation due to osteoarthritis. They constantly monitored to avoid burns.
Usually, heat therapy is combined with numbness and some particles could beother types of physiotherapy such as released (Health central 2006).massages and passive exercise. Osteoplasty is another surgical treatment Passive range of motion exercise consisting of scarping deteriorating bone(PROM), promotes sensory awareness from the joint. It is considered a surgicaland improved circulation. In addition to repair. (Springhouse 2005).PROM, stretching exercises increasetissue extensibility. Likewise, warm 7. Conclusionbaths, electric stimulation, and therapy A variety of new treatments arewith a physioball, are used to treat currently being studied. It is of great joyosteoarthritis resulting in benefits for the to know that there are people who carepatients-canines. In contrast, about this disease affecting cats, dogs,Cryotherapy (hypothermia) is applied horses and humans.using ice packs and cold compression This paper has demonstratedwraps to support vasoconstriction and some of the drugs used as treatments forskeletal muscle relaxation. These reduce osteoarthritis. Glucosamine/ Chondroitinblood flow and analgesia (inability to Sulfate have shown some positivefeel pain while conscious). (Johnston et effects based on the previous researchal.) Weight control and weight loss made. Likewise, the use of PROM willdecreases the severity of hind and limb benefit dogs in feeling less pain andweakness. gaining back their joint mobility. Since weight is an important factor in6. Surgery preventing arthritis, dogs should be feed The last method used for treating a regular balanced diet and includeand relieving osteoarthritis pain is exercise in their daily activities. There issurgical procedures. There are different no doubt that this practice will benefitsurgeries, and the most commonly done humans promoting blood circulation andis knee surgery. Arthroscopy is joint movement. By investigating andperformed as a method to clean the bone discovering new treatments, animals andsegment where inflammation is humans will surely benefit from thoseoccurring. It is a minor surgery. Another experiments. The dogs used as modelsprocedure is Arthroplasty in which MD while studying the effect ofreplaces the joint (DailyMed 2009). Glucosamine/ Chondroitin Sulfate wereThese are prosthetic joint implants. It is pets whose owners’ permitted testing.commonly used when osteoarthritis is Researchers obtained convincing results.sever making mobility almost impossible Deramaxx is another pain relieverfor the patient. Hip and knee especially for dogs, and it has alsoreplacement are the most common and shown some positive results. Adequan isthe most successful. Less common a drug that treats arthritis especially forreplacement of joints are those of the dogs too. Both are available in theshoulders, elbows, fingers, and wrists. veterinary market. In most of theseComplications are not common, and investigations, researchers foundcomprise 1 % of deaths within 3 months. different aspects that have to be realizedComplications include blood clots, for a better finding of a medication thatinfection, and hip dislocation. Some will treat at best osteoarthritis. Positiveother complications may be uneven legs, results may be obtained following the
instructions of an MD regarding the McAllister H, Seed M, Mooneyrecommended dosage. After all of the C. 2006.findings, osteoarthritis remains a branch Randomised double-blind,for further investigations to maximize positive-controlled trial toefficacy. assess the efficacy of glucosamine/chondrotin sulfateCited Literature for the treatment of dogs withDailyMed.[Internet]. [updated 12/2009]. osteoarthritis. The Veterinary Deramaxx Chewable Tablets. Journal.174, 54-61. Available from: http://dailymed.nlm.nih.gov/daily Muir P, Manley P, Hao Z. 2007. COL-3 med/drugInfo.cfm?id=13932 inhibition of collagen fragmentation in rupturedHealth Center (HC)[Internet]. [Reviewed cranial cruciate ligament 2006 April19]. My Osteoarthritis explants from dogs with stifle Central. Available from: arthritis. The Veterinary http://www.healthcentral.com/ost Journal 174, 403-406. eoarthritis/index-000035_11- 145_3.html Springhouse. Professional Guide to Disease, (eight edition).Johnston S, McLaughlin R, Budsberg S. [Internet]. [Cited 2005]. 2008. Nonsurgical Management Available from: of Osteoarthritis in Dogs. http://www.wrongdiagnosis.com Elsevier Inc. /o/osteoarthritis/book-diseases- 7c.htmMcCarthy G, O’Donovan J, Jones B,